Provider Demographics
NPI:1295110385
Name:LORANG, NICOLE (NPP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LORANG
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3362
Mailing Address - Country:US
Mailing Address - Phone:847-437-5843
Mailing Address - Fax:847-437-5859
Practice Address - Street 1:800 BIESTERFIELD ROAD
Practice Address - Street 2:SUITE 505
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3362
Practice Address - Country:US
Practice Address - Phone:847-437-5843
Practice Address - Fax:847-437-5859
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAG0715216363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAG0715216OtherSTATE OF ILLINOIS